- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $169.82
| Facility | 26 | $19.05 | $19.05 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $52.48 / $97.72
| Professional | | $30.20 | $52.48 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $22.91 / $57.54
| Professional | 26 | $15.85 | $22.91 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.00 / $33.11 / $46.77
| Professional | TC | $10.00 | $33.11 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $58.88 / $123.03
| Professional | | $22.91 | $58.88 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $21.88 / $21.88
| Professional | 26 | $19.05 | $21.88 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.12 / $36.31 / $36.31
| Professional | TC | $9.12 | $36.31 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $66.07 / $223.87
| Professional | | $40.74 | $66.07 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $31.62 / $87.10
| Professional | 26 | $20.89 | $31.62 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.18 / $37.15 / $138.04
| Professional | TC | $13.18 | $37.15 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $60.26 / $123.03
| Professional | | $50.12 | $60.26 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $22.39 / $45.71
| Professional | 26 | $19.50 | $22.39 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $38.02 / $79.43
| Professional | TC | $30.90 | $38.02 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $63.10 / $134.90
| Professional | | $28.84 | $63.10 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $28.18 / $56.23
| Professional | 26 | $17.38 | $28.18 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.77 / $31.62 / $75.86
| Professional | TC | $9.77 | $31.62 | $75.86 |